More than half of children who toe walk will stop doing so on their own by the age of five. But for those who continue to experience this condition – and to curb the problem before it’s too late – there are some highly effective steps that therapists, as well as parents and other caregivers, can take.

What is Toe Walking?

Toe walking is the failure of a child’s heel to make contact with the floor at the onset of their stance during the gait cycle. This results in a bilateral toe-to-toe gait. A majority of cases are idiopathic, though some are caused by cerebral palsy, congenital contracture of the Achilles tendon, or paralytic muscle or developmental disorders.

In the absence of any other pathology, if a child is toe walking beyond the age of two or three, the condition is generally labeled as idiopathic. Often, a family history exists, and idiopathic toe walking is more common among males than females. It may be linked to hyper or hyposensitivity: children don’t like the feeling of different surfaces on their feet, which causes them to rise up onto their toes.

Effective Treatment Options

As a physical therapist, you have a two-part role in treating toe walking. In addition to working with your young patients in office sessions, be sure to convey the importance of parents and other caregivers working with youngsters to correct this condition. Persistence and consistency will pay off.

Here’s how to make progress by focusing on:

  • Passive range of motion: With a child seated or lying on their back, hold their foot in your hand. Apply light pressure, flexing the foot up towards the child’s head. Once you feel resistance, hold for 10 to 15 seconds. Alternate feet and repeat this stretch.
  • Active range of motion: Have a child stand without shoes on a dynamic surface, such as a dyna-disc, incline wedge or wobble board. As they shift their weight to maintain balance, they will experience an active stretch of the affected muscles.
  • Strength: Target the intrinsic plantar muscles by having a child pick up small objects with their toes. Or, have them negotiate dynamic surfaces; for instance, build a pillow bridge. Focus on the anterior compartment musculature by having them navigate a seated scooter board in a forward direction; climbing stairs, or stepping over obstacles.
  • Weight bearing: Encourage barefoot standing using a variety of textures. Have a child do squats on a foam balance pad, or use textile footprint cutouts to promote alignment during an obstacle course.
  • Sensory integration: Use joint compression, vibrating cushions or nodes, tactile material shoe inserts or custom-made Grippy Socks. Proper shoe selection also can make a significant difference.

Looking for some more great tips and tools?

Do you need more tips on treating toe walking – or other tools to enhance your school-based PT practice? Or, are you using this summer break to seek your next great job and take your career to the next level? Contact the Cobb Pediatric Therapy Services team today. For close to three decades, we’ve been assisting talented therapists – and we’d love to work with you. Let’s start today!


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